Bladder Cancer - Diagnosis

What tests and exams did you have that led to a diagnosis of bladder cancer?

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How is bladder cancer diagnosed?

Bladder cancer is most frequently diagnosed on investigating the cause of bleeding in the urine that a patient has noticed. The following are investigations or tests that come in handy in such circumstances:

  • Urinalysis: A simple urine test that can confirm that there is bleeding in the urine and can also provide an idea about whether an infection is present or not. It is usually one of the first tests that is asked for by a physician. It does not confirm that a person has bladder cancer but can help the physician in short listing the potential causes of bleeding.
  • Urine cytology: This test is performed on a urine sample which is centrifuged and the sediment is examined under the microscope by a pathologist. The idea is to detect malformed cancerous cells that may be shed into the urine by a cancer. A positive test is quite specific for cancer (for example, it provides a high degree of certainty that cancer is present in the urinary system). However, many early bladder cancers may be missed by this test so a negative or inconclusive test doesn't effectively rule out the presence of bladder cancer.
  • Ultrasound: An ultrasound examination of the bladder can detect bladder tumors. It can also detect the presence of swelling in the kidneys in case the bladder tumor is located at a spot where it can potentially block the flow of urine from the kidneys to the bladder. It can also detect other causes of bleeding, such as stones in the urinary system or prostate enlargement, which may be the cause of the symptoms or may coexist with a bladder tumor.
  • CT scan/MRI: A CT scan or MRI provides greater visual detail than can be afforded by an ultrasound exam and may detect smaller tumors in the kidneys or bladder than can be detected by an ultrasound. It can also detect other causes of bleeding more effectively than ultrasound especially when intravenous contrast is used.
  • Cystoscopy and biopsy: This is probably the single most important investigation for bladder cancer. Since there is always a chance to miss bladder tumors on imaging investigations (ultrasound/CT/MRI) and urine cytology, it is recommended that all patients with bleeding in the urine, without an obvious cause, should have a cystoscopy performed by a urologist as a part of the initial evaluation. This entails the use of a thin tube-like optical instrument connected to a camera and a light source (cystoscope). It is passed through the urinary passage into the bladder and the inner surface of the bladder is visualized on a video monitor. Small or flat tumors which may not be visible on other investigations can be seen by this method and a piece of this tissue can be taken as a biopsy for examination under the microscope. The presence and type of bladder cancer can be diagnosed most effectively by this method.
  • Newer biomarkers like NMP 22 and fluorescent in-situ hybridization (FISH) are currently in use to detect bladder cancer cells by a simple urine test. However, they have not yet achieved the level of accuracy to replace cystoscopy and cytology in the diagnosis and follow-up of bladder cancer.
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